Against the ''placebo effect'': A personal point of view.

The author reviews 10 of his favorite studies which are said to be about the ''placebo effect,'' but which, instead, show the significance of meaning in a medical context. ''Placebos,'' he argues, are inert substances which can't do anything. Yet it's clear that after the administration of such drugs, things do happen. The one (and maybe only) clear thing here is that whatever happens is not due to the placebo (that is what ''inert'' means). But placebos can be of various colors and forms which can convey compelling meaning to patients. They often represent medical treatment in compelling ways; they can be metonymic representations of the entire medical experience (a metonym is a representation where a part of something comes to represent it all, as in ''counting noses,'' where the nose represents the whole person, or a ''White House statement'' where the White House represents the Executive Branch of the US Government; here, the pill represents the whole medical experience). More precisely, they can be metonymic simulacra (a simulacrum is a sort of artificial object, like a statue rather than a man, or a placebo rather than an aspirin). Such objects are well known for their powerful abilities to contain and convey meaning; for example, a European cathedral ordinarily is constructed of thousands of metonymic simulacra, from the rose window to the altar. In this context, a placebo can repeatedly remind the patient of the medical encounter, its shadings and comforts. Placebos can convey the physicians innermost feelings about medication and treatment; and the clinician can by her simple presence enhance the effectiveness of a medical procedure (and a clinician is hardly a placebo, hardly inert). Inert placebos can help us see the human dimensions of medical treatment; but calling these things ''placebo effects'' dramatically distorts our understanding of such treatments, by focusing on the inert, and avoiding the meaningful. Think ''meaning response,'' not ''placebo effect.'' [ABSTRACT FROM AUTHOR]